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NPI Code Detail

MEDICARE: JAIRO H PATINO DDS PC

MEDICARE: JAIRO H PATINO DDS PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1302F00000XExclusive Provider OrganizationIL

General Provider Information

NPI Number : 1780856757
Entity Type Code : Organization
Provider Name (Legal Business Name) : JAIRO H PATINO DDS PC
Provider Business Mailing Address
First Line : 1130 S MICHIGAN AVE APT 1809
Second Line :
City : CHICAGO
State : IL
Zip : 60605-2319
Country : US
Telephone Number : 312-405-1040
Fax Number :
Provider Business Practice Location Address
First Line : 3190 N ELSTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60618-5845
Country : US
Telephone Number : 773-267-9777
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. JAIRO H PATINO
Credential : DDS
Telephone Number : 312-405-1040
Provider Enumeration Date : 03/30/2008
Last Update Date : 03/30/2008

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